ADAMI v. COUNTY OF BUCKS

IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF PENNSYLVANIA

DAVID W.W. ADAMI, et al. : CIVIL ACTION

:

v. : No. 19-2187

:

COUNTY OF BUCKS, et al. :

MEMORANDUM

Juan R. Sánchez, C.J. April 8, 2022

This case arises from the tragic death of Plaintiff David W.W. Adami from opiate withdrawal.

At the time of his death, Adami was in the Bucks County Correctional Facility (“BCCF”) and had

received treatment from PrimeCare Medical, Inc. (“PCM”). Adami died suddenly due to symptoms

of withdrawal. Defendants County of Bucks, Steven Columbia, David Gresko, Brian Kircher, Lisa

Knoneborg, Langston Mason, Timothy Ricci and Patrick Rooney have moved for summary

judgment. Because there is no genuine dispute as to material fact as to certain claims, the Motion

will be granted with respect to Brian Kircher, Patrick Rooney, and Langston Mason. The Motion

will be denied as to all other defendants.

FACTS1

On January 27, 2018, at approximately 7:28 a.m., Adami was arrested for possession of drug

paraphernalia and admitted to the BCCC. Defs.’ SUMF ¶ 1, ECF No. 66-2. Approximately three

hours later, at 10:35 a.m., Adami was medically screened by Nurse Samantha Dunfee, who was

employed by PCM. Id. ¶ 2. Adami informed Nurse Dunfee that he had an opioid addiction, was

previously using twenty bags of heroin a day, and was experiencing chills and vomiting due to

1 The following facts are drawn from the documents in the summary judgment record. The facts

are undisputed, except where specifically noted to the contrary.

withdrawal. Defs.’ SUMF ¶ 3; Pl.’s SUMF ¶ 4. PCM, which was responsible for deciding whether

an inmate was put on medical watch, placed Adami on regular medical watch for heroin

withdrawal. Defs.’ SUMF ¶¶ 4-5.

The County of Bucks’s Watch and Observation Policy requires officers to perform rounds

every 30 minutes to check on inmates, like Adami, who are placed on Level III Medical Watch.

Pl.’s SUMF ¶¶ 17-19; Defs.’ SUMF ¶¶ 17-19. The policy also has inmate workers (inmate

monitors) perform checks on other inmates placed on Level III Medical Watch every fifteen

minutes. Pl.’s SUMF ¶¶ 18, 20; Defs.’ SUMF ¶¶ 18, 20. The inmate monitor who was supposed

to check on Adami was Kevin Foster. Pl.’s SUMF ¶24. While the documentation from the Inmate

Monitors indicates fifteen-minute checks were conducted, video footage implies at least some

checks were not performed, and Foster was in his cell on a different floor for large portions of the

night Adami died.2 Pl.’s SUMF ¶ 24.

At 12:05 p.m., Adami was assigned to Housing Unit/Module A, Cell 5. Pl.’s SUMF ¶ 9. At

12:15 p.m., PCM Nurse Deborah Buckman entered a note on the record that Adami’s intake was

reviewed. Pl.’s SUMF ¶ 6.3 No medication was ordered. Id. While Adami was traveling to Module

A, Charmaine Henderson-Mitchell, a case worker, noted Adami reported “detoxing from heroin.”

Pl.’s SUMF ¶ 8. Adami arrived at Module A at 12:23 p.m. and was assigned to the bottom bunk.

Defs.’ SUMF ¶ 7. At 1:46 p.m., Dr. Gessner, who worked for PCM, prescribed Bentyl to be taken

2 Defendants “denied” this fact in their Response to Plaintiff’s Statement of Undisputed Facts, but

did not provide any explanation, nor did they cite to the record. The record supports this assertion,

and Adami is entitled to have facts construed in the light most favorable to him.

3 The Moving Defendants deny this for lack of personal knowledge of the facts. Def’s Resp. to

Pl.’s SUMF ¶ 6. However, the record supports this assertion, and Adami is entitled to have facts

construed in the light most favorable to him.

three times daily, Bismuth two times daily, Ondansetron three times daily, and Vistaril three times

daily.4 See Pl.’s SUMF ¶ 10; see also Defs.’ SUMF ¶ 9. Nurse Dunfee entered the order. Id.

At 2:28 p.m., Officer Patrick Rooney began his shift. See Defs.’ SUMF ¶ 8. Officer Brian

Kircher also began his shift around 2:00 p.m. Defs.’ SUMF ¶ 10. At 4:47 p.m., Bruce Gramiak

was assigned to be Adami’s cellmate. Defs. SUMF ¶ 11. Adami told Gramiak he was a heroin user,

he was detoxing, and he was not feeling well. Defs.’ SUMF ¶ 12. Around 6:00 p.m., Nurse

Gabrielle Trusty saw Adami for a “Detox Check.”5 Pl.’s SUMF ¶ 11. A few hours later, at 7:01

p.m., Adami walked without assistance to the medical cart, where he waited in line to receive his

medication. Pl.’s SUMF ¶ 12; see also Defs.’ SUMF ¶ 13. Just a few minutes later, at

approximately 7:08 p.m., Officer Rooney and a PCM nurse conducted rounds. Id. ¶ 14. This was

the last time Adami was seen by another medical provider until he was found unresponsive the

next morning. Pl.’s SUMF ¶ 13.

During those rounds, Adami was not vomiting or using the toilet. Defs.’ SUMF ¶ 17.6

Gramiak told Nurse Aaron Wright and Officer Rooney that his cellmate was “really sick” and

4 The Moving Defendants deny this as they do not have personal knowledge of the facts. Defs.’

Resp. to Pl.’s SUMF ¶ 10. However, the record supports this assertion, and Adami is entitled to

have facts construed in the light most favorable to him.

5 The Moving Defendants deny this as they do not have personal knowledge of the facts. Defs.’

Resp. to Pl.’s SUMF ¶11. However, the record supports this assertion, and Adami is entitled to

have facts construed in the light most favorable to him.

6 Adami states a general denial of Defendants summary of Gramiak’s deposition testimony and

incorporates their own Statement of Undisputed Fact’s discussion of Gramiak’s deposition. Pl.’s

Resp. to Defs.’ SUMF ¶¶ 15-24; Pl.’s SUMF ¶¶ 25-30. However, Adami’s SUMF does not allege

Adami was vomiting or using the toilet around 7:08 p.m. Pl.’s SUMF ¶¶ 25-30.

asked Nurse Wright if Adami was receiving the right medication.” Pl.’s SUMF ¶¶ 28-29.7 Nurse

Wright said he would double check. Defs.’ Resp. to Pl.’s SUMF ¶ 28-29. Officer Rooney then

closed and locked Adami’s cell door. Pl.’s SUMF ¶ 29. After their conversation, Gramiak went to

the dayroom area, and did not return to his cell until 8:45 p.m., when he saw Adami sleeping. At

9:37 p.m., Officer Rooney’s shift ended. Defs.’ SUMF ¶ 8.

Officer Columbia was assigned to Module A and began his shift at 10:06 p.m.8 See Defs.’ Ex.

G (“Columbia Log Entries”). For inmates like Adami, who were on regular medical watch, Officer

Columbia was required to observe the inmates every 30 minutes. Defs.’ SUMF ¶ 29. According

to Officers Columbia and Knoneborg, if the officer performing the checks every 30 minutes cannot

see an inmate, they need to turn a light on, or use a flashlight to see the inmate. Pl.’s SUMF ¶¶ 45,

48-49; Defs.’ Resp. to Pl.’s SUMF ¶¶ 45, 48-49; Pl.’s Ex. 22, Columbia Dep. 31:24, 32:1-15.

Officer Columbia performed twelve rounds during his shift but did not perform rounds every thirty

minutes.9 Id. During at least some of the rounds, Officer Columbia walked quickly past each cell,

7 Moving Defendants dispute whether or not Gramiak told Officer Rooney that his cellmate was

“really sick.” When asked if he spoke to both Officer Rooney and Nurse Wright at the same time,

Gramiak replied “[w]ell, I was mainly speaking to the nurse because I wanted to make sure he got

the right pills and stuff. But the CO was standing right beside the nurse at the time.” Defs.’ Resp.

to Pl.’s SUMF ¶ 28-29, ECF No. 83. Given the proximity of Officer Rooney to Nurse Wright in

the video, Gramiak’s statement (“the CO was standing right beside the nurse”), and interpreting

the facts in the light most favorable to Adami, it is a reasonable inference that Rooney heard

Gramiak mention how sick Adami was.

8 Moving Defendants’ Statement of Material Undisputed Facts states Officer Columbia started his

shift at 11:06 p.m. and cites to the Columbia Log entries. Defs.’ SUMF ¶ 26. This is an incorrect

conversion of military time, as the log book states officer Columbia began his shift on 1/27/2018

at 22:06—which is 10:06 p.m., not 11:06 p.m. See Defs.’ Ex. G (“Columbia Log Entries”).

9 Officer Columbia and his relief performed checks at 10:28 p.m.; 11:05 p.m.; 11:36 p.m.; 12:29

a.m. (Knoneborg toured as relief); 1:01 a.m.; 1:30 a.m.; 1:56 a.m.; 2:29 a.m.; 2:59 a.m.; 3:29 a.m.;

4:04 a.m.; 4:31 a.m.; and 5:30 a.m. Moving Defendants assert that this was “every 30 minutes”

but, based on the logs, there appears to be a gap of almost an hour, between 11:36 p.m. and when

and did not spend substantial time visualizing Adami or the other inmates.10 Pl.’s SUMF ¶ 46; Pl.’s

Exs. 24, 25, 26.

Around midnight on January 28, 2018, 11 Adami began to use the toilet intermittently to vomit

and make bowel movements. Defs.’ SUMF ¶ 21. Gramiak estimated that Adami vomited and

defecated every fifteen to twenty minutes, and that the vomiting sounded like he was “dry-heaving

a lot.”12 Pl.’s SUMF ¶ 31; see also Gramiak Dep. 30:1-24, 31:1-24, 32:1-24, 33:1-24, ECF. No.

70-4. Gramiak did not call for help, nor did he explicitly tell an officer that Adami needed medical

attention. Defs.’ SUMF ¶¶ 23-24.

At 2:59 a.m., Officer Columbia toured Module A. Officer Columbia was then relieved for his

break by Officer Knoneborg at 3:02 a.m. Defs.’ SUMF ¶¶ 34, 40. Shortly thereafter, at 3:10 a.m.,

Sergeant Mason, who was the only first shift supervisor assigned to the entire prison, arrived at

Module A. Defs.’ SUMF ¶¶ 35-37. The sergeant is required to do at least one tour of each module,

visualizing every inmate, per shift and conduct an inspection at unspecified times. Pl.’s SUMF ¶

Knoneborg toured at 12:29 a.m. See Defs.’ Ex. G (“Columbia Log Entries”). Viewing the facts in

the light most favorable to Adami, the logbook shows that Officer Columbia’s rounds were not

conducted every thirty minutes or less. Id.

10 Defendants deny this fact. Defs.’ Resp. to Pl.’s SUMF ¶ 46. The Court has reviewed the videos,

and the record supports this assertion. Adami is entitled to have facts construed in the light most

favorable to him at the motion for summary judgment stage.

11 The following paragraph discussing Mr. Gramiak’s testimony was the source of extensive

disagreement between the parties. Adami stated a general denial of Defendants’ summary of

Gramiak’s deposition testimony and incorporated his own Statement of Undisputed Facts

discussion of Gramiak’s deposition to said objection. Pl.’s Resp. to Defs.’ SUMF ¶¶ 15-24; Pl.’s

SUMF ¶¶ 25-30.

12 Defendants dispute that Adami was using the toilet “all through the night” and cite to Gramiak’s

deposition at “77 of 125 at lines 4-10.” Defs.’ Resp. to Pl.’s SUMF ¶ 31. The portion of the record

cited contains a discussion of a prisoner who came in with Adami and spoke to Gramiak and does

not support Defendants’ assertion.

66. Sergeant Mason did not complete his round—instead, he viewed at most one or two inmates

before he departed at 3:22 a.m. for a reason he could not recall. Defs.’ SUMF ¶ 38; Pl.’s Resp. to

Defs.’ SUMF ¶ 38. However, “it was common that [Sergeant Mason] wouldn’t get all of [his] tours

done.” Sergeant Mason Dep. 78:16-22, ECF No. 68-2; Pl.’s SUMF ¶ 70. Nonetheless, Sergeant

Mason was never explicitly informed by Adami that the withdrawal symptoms were worsening.

Defs.’ SUMF ¶ 39; Pl.’s Resp. to Defs.’ SUMF ¶ 39.

Officer Columbia returned from his break at 3:22 a.m., and Officer Knoneborg left. Defs.’

SUMF ¶ 41. Gramiak does not remember seeing any guard look in to check on Adami with a light

to check during that night, but believes anyone coming to the window to check on Adami every

15 minutes would have at some point overlapped with Adami “getting up and getting sick and

vomiting and defecating.”13 Pl.’s SUMF at 32-33. Gramiak Dep. 36:1-24, 37:1-24, ECF No. 70-4.

Adami never explicitly told Officer Columbia that his withdrawal symptoms were getting worse

or his medications were not working. Officer Columbia’s shift ended at 5:43 a.m. Defs.’ SUMF ¶

27.

The next morning, on January 28th, 2018, Correctional Officers Ricci and Gresko reported to

Module A at approximately 6:00 a.m. Defs.’ SUMF ¶¶ 25, 42. Officer Ricci toured the Module at

6:06 a.m. and looked into Adami’s cell from the outside. Defs.’ SUMF ¶ 43. He saw Adami on his

bed and did not find anything unusual about the way in which Adami was on the bed at the time.

Id. Thirty minutes later, at 6:35 a.m., Officer Ricci conducted his second tour of Module A, and

noticed Adami’s position on the bed had changed and Adami’s body seemed contorted. Defs.’

SUMF ¶ 44. He yelled for his partner to call for emergency services, and additional guards and

13 The Moving Defendants deny this as they do not have personal knowledge of the facts. Def’s

Resp. to Pl.’s SUMF ¶¶ 32-33. However, the record supports this assertion, and Adami is entitled

to have facts construed in the light most favorable to him.

medical staff arrived roughly two minutes later. Defs.’ SUMF ¶¶ 45-46. The Emergency Medical

Technicians arrived and transported Adami to Doylestown Hospital, where he was declared dead

at 7:35 a.m. Defs.’ SUMF ¶¶ 45-46. The autopsy conducted by the Bucks County Coroner, Dr. Ian

Hood, concluded that the cause of death was “Sudden Death due to Opiate Withdrawal.” Defs.

SUMF ¶¶ 45-46.

DISCUSSION

A motion for summary judgment shall be granted “if the movant shows there is no genuine

dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R.

Civ. P. 56(a). Material facts are those “that might affect the outcome of the suit under the governing

law.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). A factual dispute is genuine if

“the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Id.

“[A] party seeking summary judgment always bears the initial responsibility of informing

the district court of the basis for its motion, and identifying those portions of the [record] which it

believes demonstrate the absence of a genuine issue of material fact.” Celotex Corp. v. Catrett,

477 U.S. 317, 323 (1986) (citation and internal quotation marks omitted). To defeat summary

judgment, “the non-moving party must present more than a mere scintilla of evidence; there must

be evidence on which the jury could reasonably find for the [non-movant].” Burton v. Teleflex Inc.,

707 F.3d 417, 425 (3d Cir. 2013) (alteration in original) (citation and internal quotation marks

omitted). In evaluating a motion for summary judgment, a court must “view the facts in the light

most favorable to the non-moving party and must make all reasonable inferences in that party’s

favor.” Hugh v. Butler Cty. Family YMCA, 418 F.3d 265, 267 (3d Cir. 2005). “Where the record

taken as a whole could not lead a rational trier of fact to find for the non-moving party, there is no

‘genuine issue for trial.’” Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587

(1986) (citation omitted).

The Moving Defendants argue (1) the Officer Defendants are entitled to qualified

immunity because there was no violation of Adami’s Fourteenth Amendment rights and the right

at issue was not clearly established; and (2) Adami’s municipal liability claim must be dismissed.

The Court will address each in turn.

The determination of qualified immunity requires a two-step analysis. First, the Court must

decide whether the alleged facts, construed in the light most favorable to the non-moving party,

constitute a constitutional violation. See Saucier v. Katz, 533 U.S. 194, 201 (2001). If this

requirement is satisfied, the Court must then determine whether the right violated was “clearly

established” at the time of the alleged misconduct. Id.

It is a violation of the Eight Amendment,14 for a prison official to act with deliberate

indifference to an inmate’s serious medical needs. See Estelle v. Gamble, 429 U.S. 97, 104-5

(1976). In order to survive summary judgment on a § 1983 deliberate indifference claim, a plaintiff

must show “(1) plaintiff had a serious medical need,” and “(2) the defendant was aware of this

need and was deliberately indifferent to it.” Id. at 450; see also Farmer v. Brennan, 511 U.S. 825

(1994). Because the Moving Defendants have conceded, for the purpose of the present Motion,

that Adami had a serious medical need,15 the first requirement is satisfied.

14 Adami was a pretrial detainee at the time in question, so the § 1983 claim arises under the Due

Process Clause of the Fourteenth Amendment. See Colburn v. Upper Darby Twp., 838 F.2d 663

(3rd Cir. 1988). Fourteenth Amendment Due Process claims are evaluated using “the same

standard used to evaluate similar claims brought under the Eighth Amendment.” Natale v. Camden

Cty. Corr. Facility, 318 F.3d 575, 581-82 (3d Cir. 2003).

15 See Defs.’ Mot. for Summ. J. at 5 n.3, ECF No. 66-1.

With regard to part two, there is a genuine dispute of fact regarding whether or not some

of the Moving Defendants were deliberately indifferent to Adami’s serious medical needs.

Deliberate indifference is “something more than mere negligence, . . . [but is] satisfied by

something less than acts or omissions for the very purpose of causing harm or with knowledge that

harm will result.” Farmer v. Brennan, 511 U.S. 825, 835 (1994). As a result, “a prison official

cannot be found liable under the Eighth Amendment for denying an inmate humane conditions of

confinement unless the official knows of and disregards an excessive risk of inmate health or

safety; the official must both be aware of facts from which the inference could be drawn that a

substantial risk of serious harm exists, and he must also draw the inference.” Id.

In the Third Circuit, deliberate indifference includes instances in which corrections officers

(1) deny reasonable requests for medical treatment; (2) refuse to provide medical care while

knowing it is needed; (3) delay necessary medical treatment for non-medical reasons; and (4)

prevent an inmate from receiving recommended treatment for serious medical needs. See Pearson

v. Prison Health Serv., 850 F.3d 526, 538 (3d Cir. 2017).

However, as this Court stated previously, “non-medical prison officials cannot be

deliberately indifferent “when the prisoner is under the care of medical experts and the official

does not have a reason to believe (or actual knowledge) that prison doctors or their assistants are

mistreating (or not treating) a prisoner.” Adami v. County of Bucks, No. 19-2187, 2020 WL

5849339, at *8 (E.D. Pa. Oct. 1, 2020) (quoting Pearson, 850 F.3d at 543). Additionally, there is

no deliberate indifference if non-medical prison officials simply “failed to respond directly to the

medical complaints of a prisoner who was already being treated by the prison doctor.” Durmer v.

O’Carroll, 991 F.2d 64, 69 (3d Cir. 1993).

Moving Defendants allege Adami was under the continuing care of PMC and thus,

“Plaintiffs improperly seek to hold correctional officers responsible for failing to second-guess the

medical decisions of licensed health care providers employed by Defendant PrimeCare.” Defs.’

Rep. Brief 5, ECF No. 83. The Court will grant the motion for summary judgment with regard to

Officers Kircher and Rooney on this basis.

There is no evidence in the record that Kircher knew or should have known Adami needed

medical care. Adami was seen by nurses three times during Kircher’s shift, including at 7:01 p.m.,

and was under PMC’s continuing medical care until that point. Kircher was also not present for

Gramiak’s statement about his cellmate being “really sick” and, based on Gramiak’s testimony,

Adami did not begin vomiting and having bowel movements until after Kircher’s shift was over.

Without knowledge of Adami’s worsening condition, and with Adami under the care of PCM,

Kircher cannot be deliberately indifferent. The motion for summary judgment will therefore be

granted as to Officer Kircher.

The same is true for Officer Rooney. Adami was under PMC’s continuing medical care for

the vast majority of Rooney’s shift. Even assuming Officer Rooney overheard Gramiak say his

cellmate was “really sick,” Rooney would also have heard the nurse respond and agree to check

on the medications. Furthermore, Rooney was not on duty at the time Gramiak alleges Adami’s

health deteriorated. Under Pearson and Durmer, Rooney is not required to second-guess the

nurse’s treatment decisions, especially when Adami’s condition did not significantly change

between 7:08 p.m. and the conclusion of Rooney’s shift at 10:00 p.m. The motion for summary

judgment will be granted as to Officer Rooney.

Officers Columbia, Gresko, Knoneborg, Mason, and Ricci however “were never put in a

position where they had to second guess treatment decisions by medical personal.” Adami, 2020

WL 5849339, at *9. Instead, Adami had three isolated interactions with PMC nurses: (1) when he

was first seen by Nurse Dunfee at 10:35 a.m.; (2) at approximately 6:00 p.m. when Nurse Trusty

checked his vitals; and (3) at 7:01 p.m. when Nurse Wright administered his medication. Adami

never saw a physician, nor was he scheduled to see a Nurse from 8:00 p.m. to the time of his death

eleven and a half hours later. Furthermore, per BCCF policy, the Officers were required to check

on inmates on Medical Watch every thirty minutes. Based on these facts, at the summary judgment

stage, it is reasonable to infer Adami was not “under the care” of PCM while he was in BCCF

overnight. As a result, the Court must consider whether Officers Columbia, Gresko, Knoneborg,

Mason, and Ricci were deliberately indifferent to Mr. Adami’s serious medical need.

The Court will grant the motion for summary judgment with regard to Sergeant Mason. As

this Court previously explained, Officer Mason “entered Module A for [a] one-off, isolated

purpose[], and did not interact with or observe Adami.” Adami has not disputed this statement, nor

does the record support that Officer Mason was made aware of Adami’s serious medical need

during the twelve minutes he was at Module A. In fact, as Adami concedes, Officer Mason saw at

most one or two inmates while he was at Module A. Since there is no dispute of fact regarding

Officer Mason’s knowledge of Adami’s serious medical need, he cannot be deliberately

indifferent. The motion for summary judgment will be granted for Sergeant Mason.

Moving Defendants claim Officer Knoneborg also did not interact with or observe Adami.

However, the record shows Officer Knoneborg at the very least should have observed Adami when

she “toured [the] module [and] observed all inmates” at 12:39 a.m. Defs.’ Ex. G, at 2 (“Columbia

Rounds Log), ECF Doc. 68; Pl.’s Resp. to Defs.’ SUMF ¶¶ 26-31 (which directed the court to

Defs.’ Ex. G). Knoneborg’s tour was after Gramiak alleges Adami began vomiting and making

bowel movements every fifteen minutes and, construing the facts in the light most favorable to

Adami, a reasonable jury could find Knoneborg knew Adami was sick and deteriorating, and

Knoneborg was thus deliberately indifferent. As such, the motion for summary judgment will be

denied with respect to Officer Knoneborg.

Similarly, Officers Columbia, Gresko and Ricci were all on shift in Module A after

Gramiak alleges Adami began vomiting and making bowel movements every fifteen minutes.

Construing the facts and Mr. Gramiak’s testimony in the light most favorable to Adami, a

reasonable jury could find Columbia, Gresko, and Ricci knew Adami was alarmingly sick, was on

medical watch, and ignored a serious medical need. Thus, a reasonable jury could find Officers

Columbia, Gresko and Ricci were deliberately indifferent. The motion for summary judgment will

be denied with respect to Officers Columbia, Gresko, and Ricci.16

Having found that a reasonable jury could find an Eighth Amendment violation due to

deliberate indifference to Adami’s serious medical needs by the remaining officers, the existence

of qualified immunity depends on the second prong—whether the right at issue was clearly

established. Id. The Court finds it was.

“A clearly established right is one that is sufficiently clear that every reasonable official

would have understood that what he is doing violates that right.” Kane v. Barger, 902 F.3d 185,

194 (3d Cir. 2018) (citations omitted). In order to determine if the “right at issue” was “clearly

established” at the time of the alleged misconduct, the right at issue must be defined “at the

appropriate level of specificity.” Sharp v. Johnson, 669 F.3d 144, 159 (3d Cir. 2012). However,

“it need not be the case that the exact conduct has previously been held unlawful so long as the

16 As discussed above, Defendants dispute that Adami was using the toilet “all through the night”

and cite to Gramiak’s deposition at “77 of 125 at lines 4-10.” Defs.’ Resp. to Pl.’s SUMF ¶ 31.

The portion of the record cited contains a discussion of a prisoner who came in with Adami and

spoke to Gramiak. It does not support Defendants’ assertion.

contours of the right are sufficiently clear.” Kedra v. Schroeter, 876 F.3d 424, 450 (3d Cir. 2017);

see also Hope v. Pelzer, 536 U.S. 730, 741 (2002).

In the present Motion, the Moving Defendants argue the Officer Defendants are entitled

to qualified immunity because the right at issue was not clearly established. This is incorrect. Here,

as in the motion to dismiss papers, the Moving Defendants define the right at stake far too

narrowly. Their proposed definition17 is far narrower than the “appropriate level of specificity” the

Supreme Court emphasizes when cautioning against a “high level of generality.” See id; see also

Ashcroft v. al-Kidd, 563 U.S. 731, 742 (2011). Requiring the extreme level of specificity sought

by the Moving Defendants would essentially turn qualified immunity into absolute immunity.

Instead, the Court will define the right at issue as it did at the motion to dismiss stage, “whether

Adami had a clearly established right to adequate medical treatment for his withdrawal

symptoms—a serious medical need.”18 Adami, 2020 WL 5849339, at *11. He does.

As this Court explained previously, “[a]n inmate’s right to treatment for a serious medical

need is beyond question.” Adami, 2020 WL 5849339, at *11 (citing Estelle v. Gamble, 429 U.S.

97 (1976)); see also Michtavi v. Scism, 808 F.3d 203, 207 (3d Cir. 2015) (for the proposition that

17 “[W]hether Adami had a clearly established right to medical monitoring by a correctional

officer, when the correctional officer knew that Adami was diagnosed by a physician, provided

medication, and was subject to ongoing medical treatment by the medical provider.” Defs.’ Mot.

for Summ. J. 6, ECF No. 66-1.

18 The Court acknowledges the Moving Defendants believe Navolio v. Lawrence County supports

their case. 406 Fed. App’x 619 (3d Cir. 2011). However, the facts of Navolio were entirely

different. Ms. Navolio did not die from withdrawal symptoms—instead, she died while under a

withdrawal watch when, after retrieving her medication from the nurse, she either fell or jumped

over the railing of the stairs and died as a result of the fall. The Navolio court found that

vulnerability to a risk of suicide as a result of detoxification was not a recognized cause of action.

That is fundamentally different than question at issue here, where the decedent died from

withdrawal itself.

“the Court must consider whether existing precedent placed the statutory or constitutional question

beyond debate”). For more than forty years under Estelle, it has been clear that a prison official

violates the constitutional rights of an inmate by showing deliberate indifference to the inmate’s

existing serious medical need.19 Atkinson v. Taylor, 316 F.3d 257, 266 (3d Cir. 2003). Despite

Moving Defendants’ attempt to relitigate the motion to dismiss, the Court’s opinion has not

changed. The alleged violation of Adami’s constitutional rights was clearly established at the time

of the alleged misconduct.

Because (1) a reasonable jury could find that the Remaining Officers acted with deliberate

indifference, and thus could make out an Eight Amendment violation; and (2) the right at issue

was clearly established at the time of the alleged misconduct, the remaining officers are not entitled

to qualified immunity. The motion for summary judgment will consequently be denied with

respect to the remaining officers.

Finally, the Court will deny the motion for summary judgment as to the Monell claims

against Bucks County. To survive summary judgment, Adami must prove “a [local] government’s

policy or custom . . . inflict[ed] the injury in question.” Estate of Roman v. City of Newark, 914

F.3d 789, 798 (3d Cir. 2019) (alterations in original) (quoting Monell v. Department of Social

Services of New York, 436 U.S. 658 (1978)).

A plaintiff can recover from a municipality under § 1983 by (1) identifying a policy or

custom that deprived him of a federally protected right, (2) showing the municipality, by deliberate

conduct, was the moving force behind the alleged deprivation, and (3) establishing a direct causal

link between the custom or policy and the injury. See Bd. of the County Commissioners v. Brown,

19 As stated above, the Moving Defendants have conceded for the purposes of this motion that

Adami had a serious medical need.

520 U.S. 397, 404 (1997). “Policy is made when a decision maker possess[ing] final authority to

establish municipal policy with respect to the action issues an official proclamation, policy, or

edict.” Estate of Roman, 914 F.3d 798 (3d Cir. 2019) (citations omitted).20 A Monell claim is also

established “where the failure to train amounts to deliberate indifference to the rights of persons

with whom the police come into contact.” City of Canton v. Harris, 489 U.S. 378, 387-388 (1989).

Here, there are factual disputes regarding the quantity and quality of the training the

Officers received,21 which could lead a reasonable jury to find that the County, through its policy,

was deliberately indifferent to the needs of prisoners going through opiate withdrawal. Adami

allege the officers (1) did not receive adequate training to monitor inmates going through

withdrawal and thus, (2) many did not consider vomiting worthy of reporting or were trained to

use their discretion.22 Defendants disagree and assert correctional officers are trained “to call

20 Of course, a finding of a constitutional violation is a prerequisite to finding a municipality liable

for an injury under § 1983. City of Los Angeles v. Heller, 475 U.S. 796, 799 (1986). As detailed

above, a reasonable jury could find that a state actor violated Adami’s Fourteenth Amendment

rights, so the direct claim does not fail as a matter of law.

21 Since the motion must be dismissed on the basis of the failure to train the officers, the Court

does not address the merits or lack thereof on the arguments regarding the use of inmate monitors.

22 Based on the record, a reasonable juror could find that the officers did not receive appropriate

training, despite regularly interacting with individuals going through withdrawal. For example,

Officer Columbia stated he did not recall what training he received regarding observing inmates

going through withdrawal. Columbia Dep. 26:15-24, ECF No. 70-5. When asked if he recalled

“receiving training at Bucks County to call medical if inmates are detoxing and experiencing

symptoms, Officer Columbia stated, “it was based on the discretion with the severity they’re going

through,” and reiterated that “you had to use discretion” and that “[the officers] were trained to

call depending on their symptoms.” Columbia Dep. 27:1-24.

When asked “what training he received with regard to inmates going through opiate detox

or opiate withdrawal,” Officer Rooney said he “could not remember anything specific.” Rooney

Dep. 18:8-12, ECF No. 70-5. When asked who taught his training with regard to drug withdrawal,

Officer Rooney recalled that the academy instructions were Lieutenant Mannarino and Lieutenant

Lall. Rooney Dep. 18:13-23, ECF No. 70-5. Officer Rooney also said he could not recall having

“any training on drug withdrawal provided by any medical personnel.” Rooney Dep. 20:10-16,

ECF No. 70-5.

medical if she/he observes an inmate under some form of medical distress regardless of a

designated illness.” Defs.’ Mot. for Summ. J. 13, ECF No. 66-1 . Since Plaintiffs have provided

sufficient evidence that a reasonable jury could find BCCF failed to train these officers, and that

such a failure amounted to deliberate indifference, the motion for summary judgment will be

denied with respect to Bucks County.

BY THE COURT:

/s/ Juan R. Sánchez

Juan R. Sánchez, C.J.